2003-04 Avian Influenza Outbreak
During December 2003--February 2004, outbreaks of highly pathogenic avian influenza A (H5N1) among poultry were reported in Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam. As of February 9, 2004, a total of 23 cases of laboratory-confirmed influenza A (H5N1) virus infections in humans, resulting in 18 deaths, had been reported in Thailand and Vietnam. In addition, approximately 100 suspected cases in humans are under investigation by national health authorities in Thailand and Vietnam. CDC, the World Health Organization (WHO), and national health authorities in Asian countries are working to assess and monitor the situation, provide epidemiologic and laboratory support, and assist with control efforts. This report summarizes information about the human infections and avian outbreaks in Asia and provides recommendations to guide influenza A (H5N1) surveillance, diagnosis, and testing in the United States.
The majority of the human H5N1 cases are apparently associated with direct exposure to infected birds or to surfaces contaminated with excretions from infected birds. The family respiratory illness cluster in Vietnam suggests the possibility of limited person-to-person transmission. However, other possibilities (e.g., transmission through exposure to surfaces contaminated by H5N1-infected poultry feces) cannot be ruled out. Although no evidence for sustained person-to-person transmission of influenza A (H5N1) has been identified, influenza viruses have the capacity to change quickly. Continued monitoring for new transmission patterns is an important aspect of the current investigation.
Information on Influenza A (H5N1)
Background: Influenza A (H5N1) is a subtype of the Type A influenza virus. Wild birds are the natural hosts of the virus, hence the name avian influenza or bird flu. The virus was first isolated from birds (terns) in South Africa in 1961. The virus circulates among birds worldwide. It is very contagious among birds and can be deadly to birds, particularly domesticated birds like chickens.
Infection: The virus does not typically infect humans. In 1997, however, the first instance of direct bird-to-human transmission of H5N1 was documented during an outbreak of avian influenza among poultry in Hong Kong; the virus caused severe respiratory illness in 18 people, of who 6 died. Since that time, there have been other instances of H5N1 infection among humans. (See "Basic Information about Avian Influenza.") But so far, H5N1 viruses have not been capable of efficient human-to-human transmission. This is something that is being watched carefully and is being investigated during this outbreak.
Spread: Infected birds shed virus in saliva, nasal secretions and feces. Avian influenza viruses spread among susceptible birds when they have contact with contaminated excretions. It is believed that most cases of H5N1 infection in humans have resulted from contact with infected poultry or contaminated surfaces.
Symptoms of Avian Influenza in Humans
The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g., fever, cough, sore throat and muscle aches) to eye infections, pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications.
CDC Avian Influenza web site
MMWR February 13, 2004 / Vol. 53 / No. 5. Outbreaks of Avian Influenza A (H5N1) in Asia and Interim Recommendations for Evaluation and Reporting of Suspected Cases --- United States, 2004
World Health Organization (WHO) web site
World Organisation for Animal Health (OIE)
Public Health Page